Article | Eliminating Hepatitis C could stop the clock on a health timebomb

Ahead of World Hepatitis Day (28th July) Dr Ian Wood, a GP and Optum (formerly EMIS) Clinical Director, discusses why the World Health Organisation’s (WHO) goal to eliminate Hepatitis C isn’t just about the virus – it’s also about helping to curb rising rates of preventable deaths from liver disease and cancer.

In 2020 the number of people in England who died with liver disease rose to 10,127. A stark contrast to EU countries where deaths from the largely preventable disease are declining.

Most cases of liver disease are linked to three main risk factors – alcohol, obesity and viral hepatitis - all of which can be managed.

Hepatitis C is a specific form of liver inflammation caused by the Hepatitis C virus (HCV). Some people will clear the virus themselves. But a bigger proportion will develop a chronic Hepatitis C infection - of which a sizeable group will go on to develop irreversible liver damage called cirrhosis or even liver cancer.

In 2020 the rates of premature deaths from Hepatitis C related end-stage liver disease or liver cancer did marginally decline, from 243 in 2019 to 237. But for a virus that now curable, those figures -albeit reduced - make for depressing reading. (1)

While the World Health Organisation (WHO) has set the target to eliminate Hepatitis C worldwide by 2030, NHS England has an even greater ambition of reaching that goal five years earlier, by 2025.

It’s a programme I, and the wider EMIS [now Optum] team, have been fortunate to be involved in. It presents a rare, but exciting opportunity to eliminate Hepatitis C. But there is one big challenge – finding the undiagnosed who may have no symptoms or any suspicion that they have Hepatitis C.

Dr Ian Wood
GP and Clinical Director

According to Public Health England an estimated 95,600 people are living in England with Hepatitis C who have neither been diagnosed or treated. The word ‘estimated’ is important here, because we actually don’t know the true scale of the undiagnosed. It could indeed be far higher.

Caught early, Hepatitis C is a curable condition which today has a success rate with treatment of 95 per cent. But it’s also caused by a virus that people can live with without experiencing any symptoms for decades. Too often, at the point Hepatitis C is diagnosed it’s too late and it has progressed.

Waiting for patients to present to us with symptoms is too late. It’s causing unnecessary premature deaths and strain on the NHS. We need to take the help to them.

Screening for Hepatitis C comes with a variety of challenges too. Many people who may be at risk are on the periphery of society, homeless, in unstable housing, or are disengaged with public services.

English may not be a first spoken language, or understood at all, and other wider social determinants of health such as poverty, employment and education can make health prioritisation feel like a luxury they can ill afford. This all fosters inequitable access to healthcare for this at-risk group.

But, there are opportunities for proactive, preventative, continuity of care which drive forward and supports successful health screening programmes.

As part of the NHS’ drive to achieve Hepatitis C elimination by 2025, over the last few years we’ve seen tremendous strides in reaching out to some of the hardest to reach – primarily through drug services, sexual health clinics and screening programmes carried out in prisons.

These programmes are without question lifesaving. But they can also perpetuate the misconception that Hepatitis C is a virus that only impacts a certain demographic.

It’s believed that many of those yet to be diagnosed with Hepatitis C are using primary care services. This is a key driver for a pilot screening programme being launched which realises the value and power of primary care data, combined with EMIS-X® Analytics, in identifying cohorts of patients across a region who might benefit from an intervention.

Not only this, but it will also do so bearing in mind capacity. In the current climate, it could not be more important to ensure new programmes like this do not add any additional pressure on already overstretched GP practices.

Primary care records provided a vital role during the pandemic – helping to identify those most at risk of COVID-19 to aid shielding and also prioritisation of vaccination. Similarly, primary care patient record insight will be vital to eliminating Hepatitis C and in turn, reduce the number of unnecessary deaths linked liver disease and cancer.

Dr ian wood 1 — Dr Ian Wood, GP and Clinical Director

This article reflects our collaboration with MSD as part of NHS England's Hepatitis C Elimination Programme at the time of publication, and was part of MSD’s committed investment towards the programme. This partnership has since concluded.